保肝解毒汤保留灌肠联合水飞蓟宾治疗非酒精性脂肪性肝炎的临床研究

Clinical Study of Baogan Jiedu Decoction Retention Enema Combined with Silybin in the Treatment of Nonalcoholic Steatohepatitis

目的:观察保肝解毒汤保留灌肠联合水飞蓟宾治疗非酒精性脂肪性肝炎的疗效,为此病的治疗提供新的给药途径及治疗思路。方法:采用随机数字表法将60例非酒精性脂肪性肝炎患者分为治疗组和对照组,每组30例。治疗组给予保肝解毒汤保留灌肠,同时口服水飞蓟宾胶囊(水林佳)治疗,对照组给予口服水飞蓟宾胶囊(水林佳)治疗。30 d为1疗程。观察两组患者治疗前后肝功能(包括ALT、AST、GGT)、血脂(包括TC、TG、LDL-C)、中医证候积分及肠道菌群的变化情况。结果:治疗30 d后,治疗组的总有效率达93.3%(28/30),明显优于对照组的70%(21/30)。两组患者治疗后中医证候积分、ALT、AST、GGT、TC、TG、LDL-C均有降低(P<0.05),且治疗组下降幅度明显优于对照组(P<0.01)。两组患者治疗后肠道菌群中的双歧杆菌、乳酸杆菌均有升高,而大肠杆菌、肠球菌有所下降(P<0.05),且治疗组改善程度明显优于对照组(P<0.01)。结论:保肝解毒汤保留灌肠联合水飞蓟宾胶囊能显著改善NASH患者的临床症状,通过调节肠道菌群、恢复肠道微生态达到改善肝功、降低血脂的目的。

Objective:To observe the curative effect of Baogan Jiedu Decoction retention enema combined with Silybin in treating nonalcoholic steatohepatitis(NASH),and to provide a new way of administration and treatment ideas for the disease.Methods:60 patients with NASH were randomly divided into the treatment group and the control group,with 30 cases in each group.The control group was treated with Silybin Capsule(Shuilinjia);on which basis,the treatment group was also treated with Baogan Jiedu Decoction retention enema.30 days were taken as one course of treatment.The changes of liver function(including ALT,AST,GGT),blood lipid(including TC,TG,LDL-C),TCM syndrome score and intestinal flora were observed before and after the treatment.Results:After 30 days of treatment,the total effective rate was 93.3%(28/30)in the treatment group,which was significantly higher than 70%(21/30)in the control group.TCM syndrome score and the values of ALT,AST,GGT,TC,TG and LDL-C were significantly decreased in the two groups after the treatment(P<0.05);of which the decreases were more significant in the treatment group(P<0.01).After the treatment,Bifidobacterium and Lactobacillus of intestinal flora were increased,whereas Escherichia coli and Enterococcus were decreased in the two groups(P<0.05);of which the improvements were more significant in the treatment group(P<0.01).Conclusion:Baogan Jiedu Decoction retention enema combined with Silibinin Capsule can significantly improve the clinical symptoms of NASH patients,the therapy can improve liver function and reduce blood lipid by regulating intestinal flora and restoring intestinal microecology.